Endovaskuläre Therapie des Aortenbogens

Background: Open surgical treatment represents the gold standard for pathologies of the aortic arch. Despite surgical, anesthesiological and technical developments of open surgery, hypothermic circulatory arrest with a high perioperative risk is still necessary and cannot therefore be used for multimorbid patients. Endovascular techniques have made impressive developments over the last 20 years and are the treatment of choice for pathologies of the descending aorta. In emergency situations, such as ruptured or symptomatic aneurysms and in multimorbid patients, endovascular techniques are currently becoming a treatment alternative for lesions of the aortic arch. Due to the complexity of the aortic arch with its supra-aortic vessels, angulation and proximity to the heart, endovascular treatment is a challenging task. Objective: Which therapy options are offered by endovascular techniques for individual patients? Results: Endovascular treatment options for the aortic arch include hybrid debranching procedures and endovascular techniques, such as fenestrated and branched stent grafts, chimney graft procedures and in situ fenestration. Customized fenestrated and branched stent grafts are considered to be a good alternative treatment for patients unfit for open surgery and could become the treatment of choice in the future. Chimney grafts and in situ fenestration are suitable as valuable bail-out strategies for aortic arch pathologies. Conclusion: Endovascular techniques are rapidly developing and improving and have currently become a valid alternative treatment in specialized centers for high risk patients with aortic arch pathologies.